The Hierarchies of Slavery in Santos

I wouldn't be using this space well if I didn't make at least one plug for my new book The Hierarchies of Slavery in Santos, Brazil: 1822-1888, (Stanford University Press, 2011)  The book argues that slavery was hierarchical and slave opportunities for action often dependent on their position and the prestige of their owner.  We typically think that all slaves were treated with equal brutality, but this was certainly not the case.  In Southeastern Brazil at least, doors opened or closed for all kinds of important opportunities -- including freedom -- at different times for different slaves.   Slaves of wealthy owners may have faced some greater hardships (i.e., stricter observation, more jailtime for offenses), but they were often more likely to receive medical attention and live in more comfortable settings.  Slaves, of course, were not oblivious to inequities within bondage.  I believe this tempered some rebelliousness slaves felt toward the institution as a whole.  If life offered "opportunities" within slavery and it was obvious that some slaves had received "breaks," then the incentive to collectively push against the institution as a whole diminished.  

It was this research that turned my interest toward the medical history of Brazil, since Santos remains infamous in Brazil for the scourges of yellow fever and smallpox that devastated the port city during the late 1800s. Santos was a dreaded place to navies when thousands of foreign mariners died in port each year.  Chapter five of Hierarchies of Slavery discusses health conditions, medical treatment, epidemics and slavery.

Please consider buying this book.  Doing so won't make me any money, but it will reduce the pressure that academic presses now face to induce expensive "subsidies" from their authors.  We need academic presses to remain economically viable since primary research is not something that can be done and sold for a profit.

Brazil's Era of Epidemics in a Hemispheric Context

A series of unfamiliar and devastating epidemics struck Brazil in the second half of the nineteenth century.  These epidemics had a profound impact on Brazil’s political, economic and social development when the boundaries of deadly and frightening scourges of yellow fever, cholera, malaria, bubonic plague, and smallpox shifted across national boundaries.  These diseases altered because of intentional human action (i.e., smallpox vaccination campaigns), but more frequently changed because of unintentional actions (agricultural drainage and nutritional improvements decreased malaria incidence) or non-human habitat changes (the distribution of aedes aegypti mosquitoes, the vector of yellow fever, altered).  This project places Brazil’s “era of epidemics” (1849 – 1910) within a broader context of 1) divergent hemispheric development and 2) pathways for disease movement.  The nineteenth century was, after all, a time of clipper ships, packet boats and steam engines, and the Atlantic and Pacific Oceans composed the wider region’s primary passageway for the increasing flow of goods, people, and microbes during the second half of the nineteenth century.

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Did Brazil's First Railroads Worsen Smallpox?

In a week I’ll present a paper at a historical conference that smallpox became a much bigger problem throughout Brazil during the second half of the nineteenth century.  I estimate that more than one million Brazilian were killed by smallpox between 1850 and 1900, more than those killed by the other increasingly fearsome diseases of the day (cholera and yellow fever) and more than those killed by smallpox before 1850 and after 1900.  That smallpox worsened in Brazil is not a well recognized fact. 

In São Paulo and in other parts of Brazil, smallpox epidemics increased in frequency after 1850.  In the table below, we see outbreaks as they were reported by the annual São Paulo President’s and Governor’s Reports.  Some years, São Paulo’s provincial president vaguely described smallpox as occurring “throughout the state,” but it is unlikely that every or even most township had outbreaks those years.  in the 14 years between 1837 and 1850, there were four epidemics.  In the 14 years that followed, there were nine.

In some places, such as Santos, smallpox mortality rose until the 1880s, before declining (see figure below).  Epidemics, however, became more virulent until the 1890s, before they largely vanished due to far more effective and financed public health efforts under the new Republican government.   Similarly, in Rio de Janeiro, smallpox epidemics became more frequent and general mortality increased until the 1880s, before declining.  Rio de Janeiro experienced two terrible outbreaks of smallpox in 1904 and 1908 during a decade when São Paulo suffered no major epidemics.  This was an eradicable disease:  European governments had begun greatly reducing the threat of smallpox as early as the 1830s.

I plan to discuss how railroads facilitated the spread of smallpox.  In the map below, we can see various township centers connected by the railroad (grey line).  The red circles indicate epidemics that occurred between October and December, 1892.   Township centers without railroad states, including Tieté, Porto Feliz, Cajurú, Riberão Bonito, Socorro, Serra Negra, Caconde, Nazare Paulista (Nazareth), Maripora (Jaquery) and others, avoided this disease.

Other factors that may have prompted the spread of smallpox include large populations, large population growth (between 1872 and 1890), or proximity to navigable rivers.   In the final table we can see that the size of the population mattered, but there was a larger correlation between railroad stations and smallpox epidemics.  

Contemporaries were not blind to the fact that trains carried smallpox and, in fact, stations were closed when epidemics occurred.  Three local outbreaks reported by the Diário Official do Estado de São Paulo in 1891 occurred within walking distance of the train stations in São Paulo, Bocaina, and Conchas.

This is not the only disease that railroads helped make into a worse problem.  In 1889, yellow fever appears to have been greatly aided in spreading to “virgin soil” populations in interior São Paulo, devastating towns such as Campinas (see my previous post).   Railroads may have accelerated growth in Brazil, but historians who have estimated savings brought by railroad building have not yet included the enormous costs of these two contagious diseases. 

Mapping Smallpox in São Paulo

This is the first time we can visualize smallpox as it appeared and shifted in form in Imperial Brazil. Smallpox was no minor concern: it was the most destructive and feared disease across much of interior Brazil.  In its most virulent form, smallpox killed one in four infected, usually as a result of internal bleeding.  In its mildest form, it stole vision and beauty from the faces it touched.  As a pathway to death, smallpox is overtly undescribable, yet it occurred with such frequency to leave a widespread and profound sense of its power.  And it had a noticable personality, for unlike the other top killers of the day, it picked its victims from all kinds of people, not discerning pampered rich boys from slaves outcast at old age.  

Considering its importance for day-to-day life in Brazil, it is remarkable that we know so little about it.  Were people helpless? Did the Emperor, provincial presidents and town mayors not fight back?  Remember that this was the only major disease that European governments and charitable organizations had successfully resisted through public health programs and stringent laws as early as the 1820s.  Did Brazilians organize and finance institutions to provide vaccination for those who needed them?  Historians have guesses (i.e., the imperial government was too weak and poor), but few firm answers. 

I'll be putting more up as things develop. For the full series of maps, please click here.  



Smallpox in São Paulo, 1863

Tetanus among Slaves and Free People in Porto Alegre

Figure 1.

 

Figure 2.

Figure 3.

Because tetanus mostly strikes newborn babies whose umbilical stumps become infected through unhygenic post-natal care, this disease is a unque indicator of medical treatment and life conditions.

These three graphs demonstrate that tetanus, a frequent killer in the 1850s, become a rare disease by the 1890s in the large southern Brazilian city of Porto Alegre.  For a description of tetanus and this current project, see my earlier post.  As seen in Figure 1, infant mortality also declined (at least in relation to deaths of other age groups).  This gives us strong evidence that as tetanus disappeared, newborns had a greater chance of living.  Interestingly, tetanus among slaves showed an opposite trend, as we can see in Figure 2.  Between 1850 and 1870, tetanus increased as a cause of about 3 percent of total slave deaths to 5.5 percent.  This may have been a consequence of the end of the international slave trade in 1850 because after this point, the male to female sex ratio fell and, possibly, more slaves had chidren.  But as an aging population, I would expect to see a falling percentage of tetanus deaths since this group was much older on average and less prone to infantile afflictions.  Data from Santos shows tetanus rates falling even among slaves during this same period so it may be simply that conditions and treatment of slaves in Porto Alegre worsened despite their rising price.  I excluded data after 1871 since all babies born to slaves were legally free in Brazil when the Imperial government passed the "Free Womb Law" in 1872. Figure 3 demonstrates that even though relative rates of tetanus may have been on the rise among slaves, by the 1890s -- after slavery was abolished -- the gap between the (wealthier) white population and the (poorer) "people of color " (i.e., pretos, pardos, morenos, etc.) vanished.  This is another surprising finding since most historians assume that whites continued to recieve superior medical treatment compared to non-whites.

Data is taken from 46,254 free people and 6,739 slaves who were buried in the cemetery of the Santa Casa de Misericordia in Porto Alegre between 1850 and 1898.

For a short discussion of possible bias in the obit data of tetanus deaths, view this.

"Save the Babies" and other historiographical conversations

"One way to address and analyze the impact of Brazil's Era of Epidemics on public policy, overall population welfare, changes in treatments, and other areas of interest is to compare the Brazilian context with the epidemic context of another large country in the Western Hemisphere: the United States. This blog post will summarize existing historiography of U.S. health related to infectious diseases in the second half of the nineteenth century. Since the focus is on infectious diseases with epidemic potential, this review has a more narrow scope than U.S. health historiography generally for the period. Many studies exist on mental health, chronic disease, cancer, heart disease, and other health concerns in the nineteenth century; their exclusion here does not necessarily reflect a small place in the literature. Studies conducted by demographers, geographers, and economic historians also have a big presence in this review because their methodologies often analyze mortality.

Existing research, as may be expected, generally follows the existing sources. Census data years, military records, especially concerning Civil War soldiers, surveys of cities like Philadelphia with early vital statistics record-keeping, and hospital data all dominate the literature on non-slave populations. Slaves welfare has a large place in the historiography which is discussed in detail below. I will begin with a summary of..."

Click here for the rest of this excellent historiography by Glynnis Kirchmeier.

Tetanus in Brazil

Opisthotonus, Charles Bell

Tetanus has become the latest focus of the EE project.  This disease is usually the result of a wound infected by the Clostridum tetani bacteria.  As this microbe multiples it release a neurotoxin that can quickly become fatal if untreated.  Poisoning is accidental, since the nuerotoxin is a natural byproduct of its life cycle.  It is a terrible accident, though, since it causes spasms and tightened muscles, especially around the jaw (hence its older popular name "lock-jaw") and  back (called opisthotonos, see image).  One of its most tragic manifestations is neonatal tetanus, usually due to an infection at the umbilical stump caused by a dirty cut or contaminated poultice.  In some parts of Brazil as many as one out of three infants died from neonatal tetanus.   Millions of mothers and fathers watched their newborns stop feeding and arch in pain for days before dying.   

I have only just begun to look at the data, but so far I have found a large drop in in the incidence of neonatal tetanus around 1890 in some parts of Brazil, right around the time that European and Japanese doctors discovered and isolated the tetanus bacteria.  As the same time, there are still a sufficient cases of neonatal tetanus in the early 1900s, indicating that asceptic practices were uneven.  What fascinates me about this disease is how connected it is to medical practice and belief.  By understanding the history of tetanus, we will have a much better idea of how foreign medical knowledge disseminated in Brazil and how quickly medical and midwifery practice changed.  A fuller description of this research can be found here.

US Medical History Resource

Glynnis Kirchmeier, a former student of mine at the University of Puget Sound, has been an enormous help to the EE project by gathering material related to the history of health and disease in the United States during the nineteenth century.  While little is known about general patterns of health during this time, most evidence points to improvements in mortality for Americans.  By comparing the US and Brazil, we hope to get a better idea of hemispheric trends.  For example, in Brazil during the 1800s, some important diseases became more serious threats, including yellow fever, cholera and bubonic plague.   Except for yellow fever in the southern United States, the opposite seems true for these three diseases in the US.  Here are details on relevant articles and graduate theses.  These will be updated as it is expanded.

Steamboats, Yellow Fever, and Making Maps Move

I hope this video, shown recently at BRASA, gives support to several arguments.  The first is that yellow fever most likely appeared in Brazil in 1849 (for the first time in 157 years) because it was transported on ships carrying migrants on route to mine gold or settle in California.  Contemporaries blamed a ship arriving with 49ers as the cause of the outbreak in Bahia, but this is not widely known or discussed by historians today.  In fact, historians more commonly connect the slave trade with the outbreak of yellow fever, although this seems improbable for reasons that I'll save for another post.

Second, yellow fever moved inland both in the United States and Brazil with the help of steam propelled riverboats and locomotives.  See my previous post for evidence that it also followed railroad routes.  

There is an important implication to the disease's dramatic movement.  Yellow fever, cholera and bubonic plague were all absent in Brazil during the first half of the 19th century, but caused hundreds of thousands of deaths during the second half.  Smallpox also worsened in mortality, killing millions.  For the United States, all of these diseases except bubonic plague were present, but were worse during the first half of the century.  Therefore, we should include the changing epidemiological environment with geography and institutions as the main reasons why the development gap between these two countries widened between 1850 and 1900. 

The last argument was methodological, and I hope it became apparent in the video/slide show.  I believe that visually representing spatial data not only gives us the tools to make connections we might not have made otherwise, but it helps build support for our arguments.  It is one thing to say that steamboats preceded outbreaks of yellow fever on the Mississippi, São Francisco and Amazon Rivers, but another thing to show the arrival of the steamboats and outbreaks on a geocoded map changes over a set time period.

Ministry of the Empire Reports are now "Searchable"

 

Many of the day-to-day affairs of the Brazilian Empire (1822-1889) were overseen by the Ministerio do Imperio (Ministry of the Empire).  Once or twice a year this Ministry published an update of the Empire's state of affairs, including reports on schools, municipal elections, and the imperial family. These reports are valuable for this project because they became increasingly detailed in their discussion of public health following the outbreaks of yellow fever and cholera in the 1850s. By the 1860s, they included special reports written by Brazil's top health authorities.  Beyond health, historians studying education or searching for details on some of the smaller provinces will also find them to be a rich primary source.

Ministerial Reports are one of the most accessible primary sources for the imperial period because they can be read online though the Center for Research Libraries (CRL) website.  The CRL does an invaluable service making these available without any special licence or access.  Historians are limited by this source, however, by their length  (as many as 1000 pages for some in the 1870s) and the lack of detailed index.  Furthermore, the CRL only holds page images that have not, until now, been OCR processed.  Without machine readable text, they cannot be searched, making the task of finding answers to specific questions much like finding a needle in a haystack.

I've been working with my father for more than a year now to make part of the enormous collection of government documents at the CRL searchable.  My father created a web-based program that runs on a Linux server and uses MySQL to store and retrieve text records. A separate Python program processes the OCR text information and organizes it in the MySQL database. This technology allows anyone with an internet connection to be able to search the Ministry of the Empire reports by keyword or character combination here.  In total, there are 19,640 pages from 60 reports covering the period 1832-1888.

One caveat:  Often the image or text quality is so poor that our OCR program (AABBY) couldn't read the text correctly.  This means that there are many misspelled words or misidentified characters.   Working around this problem, we included regular expressions searches, a powerful way to find words using wildcard characters or other expressions.  We've also included a quick link to a specially created .pdf page and the CRL's page image for each returned search hit, and these are often easier to read.

Eventually we would like to expand to include more reports.  Even though this could be done for a relatively small price, the cost for us at this point is prohibitive.   We are looking for sources of funds that could make this possible and are open to any ideas.  Potentially, the program's use could be greatly broadened because it could provide a search engine for other primary sources that have been OCR processed. 

The Mysteriously Shifting Distribution of Yellow Fever

I've been looking closely at the hemispheric distribution of yellow fever during the 19th century as part of research for an upcoming conference.  Using several secondary sources that list outbreaks of yellow fever in the United States, I created a map that shows yellow fever in the United States from 1790 to 1910.  I've done this before, but in less detail.

Yellow fever outbreaks in the US from 1790 to 1909 from Ian Read on Vimeo.

A few things stand out in this map.  First, yellow fever left its greatest mark on the eastern seaboard and, especially, in the northeastern ports between 1790 and 1820.  After this period, it lingered in this area, but also expanded southward, mostly in the Gulf Coast region. During the 1810s, it took root in and near the Mississippi delta.  Yellow fever appears to become endemic in New Orleans.  By the 1820s, it slowly but erratically spread up the Mississippi River.  The Texan Gulf also had a first outbreak.  By 1854, yellow fever was now a “southern” disease, with periodic outbreaks in the gulf and delta areas especially.  The 1878 epidemic was memorably severe in how far it spread inland (more on that in a minute) and high levels of mortality.  There were fewer epidemics during the 1880s, but yellow fever returned with virulence in the south in the 90s.  After 1901, health officials learned that yellow fever was transmitted by the (aedis aegypti) mosquito and in the next few years health boards attempted mosquito larva eradication programs.  Such programs diminished but did not halt the last major epidemic, in 1905.

I'm building a similarly detailed map for Brazil, but this is a more difficult task because far fewer historians have collected yellow fever statistics.  But from what we know, yellow fever and its mosquito vector shifted considerably in its range.  For instance, in São Paulo during the 1850s, the disease was almost entirely confined to the coast and only took its victims from an area not far from the international port at Santos.  Even though the coffee boom in the following decade brought many more ships, non-immune European sailors and immigrants, yellow fever had largely vanished.  It returned in 1870 and began to spread inland.  By 1889, yellow fever mosquitoes had crossed the tall mountain range and entered the Paulista highlands, where thousands of coffee trees were producing most of the world’s coffee, bringing new wealth to Brazil.  Epidemics occurred in coffee towns previously thought to be immune to the fever until 1903 when the last major outbreak occurred in Riberirão Preto.

This changing distribution of the disease in inland US and Brazil was largely caused by railroad cars that transported infected insects and people into areas with low levels of immunity.  In the two maps below, we can see that the outbreaks in Texas (1862-73) and São Paulo (1889-1903) usually occurred near the railroads.  In fact, Houston and Campinas were both hubs of two strikingly similar disease networks.  Residents were well aware of the threat that this new technology brought, and in both instances, the railroads were closed during (but not before) some of the worst epidemics.

Although there is little doubt that transportation technology like railroads and riverboats contributed greatly to the expanding and changing distribution of yellow fever outbreaks, it is much harder to explain why yellow fever shifted from the American east coast to the south and why yellow fever was not even present in Brazil between 1693 and 1849.  Furthermore, yellow fever epidemics were less common in both countries during the 1860s and 1880s than the 1850s, 1870s and 1890s.  I believe that these changes were caused not by something that people did, but by naturally shifting boundaries of the mosquito host.  

Rio de Janeiro and Boston´s vaccination “revolts”

When the Brazilian congress approved the Mandatory Vaccination Law in 1904, public health officials and police were given the power to enter homes and vaccinate for smallpox by force.  Many Brazilians at this time, especially among the poorer classes, saw vaccine as either ineffective at best or deadly at worse.  In fact, smallpox vaccination still carries a small risk of illness or even death, so this worry was not entirely displaced. To many, the main problem was the intrusion by the state into homes and control over bodies, including those of wives and daughters.  During the second week of November, Rio de Janeiro spiraled into revolt over the compulsory vaccinations.  Cariocas (residents of Rio) overturned trams, barricaded streets, and fought police with sticks and rocks.  The revolt succeeded in the short run; the government was forced to temporarily suspend the vaccination program.  Despite this public upheaval, the program resumed and within a few years was showing successful results in lowering the incidence of smallpox in the Republican capital and other urban areas of Brazil.

Many Brazilians learn about the “Revolta da Vacina” as school children, but few know that similar events occurred elsewhere, including in Boston.  For example, when smallpox became epidemic in Boston in 1901, taking hundreds of lives, the Boston Board of Health sent “virus squads” that targeted mostly poor men living in tenement housing.  The Board met considerable resistance, like in Rio de Janeiro.  A reporter to the Boston Globe who accompanied one of these squads described a “fighting tramp,” who “went down in a heap on the floor” from the blow of a policeman's club.  This poor man received both vaccination and suturing of his scalp, according to this wonderful short article on the episode.  The resistance in Boston did not turn into violent mobs like in Rio de Janeiro, but vaccination opponents fought the efforts of the state on multiple levels, including in court.  One case went as far as the Supreme Court, which ruled in support of a state’s right to force vaccinations in order to protect the public during dangerous epidemics.   Today, it may be not unconstitutional for the U.S. government to force vaccinations in the face of an outbreak of a deadly and contagious disease.

The top illustration, published in the Revista da Semana in 1904, shows the Brazilian povo (people) begging mercy from the stern congresso (congress) wearing a Roman tunic.  Below, we see a various scenes from Boston's obligatory vaccination campaign published in the Boston Globe in 1902.  This includes a child “protecting mama” and a man who “strenuously objected.”

Cholera Epidemic of 1855-1856 Mapped Using Google Earth

This will need a few minutes to load, but once ready, this video animates the spread of cholera during the great epidemic of 1855-1856.  It focuses on the western seaboard, and shows how it struck the ports of Bahia (July, 1855) and Rio de Janeiro (Sept, 1855) moving into the interior, almost always along waterways.  I have animated these maps before, but this is the first time using Google Earth.  More information on the spatial movement of this epidemic can be found here. 

New Database Offers Searchable Newspapers

I recently received an email from a company called Readex that helped digitize and OCR process millions of pages of Latin American newspapers.  Included in this set are  the Jornal do Commerico (Rio de Janeiro), 1884 - 1901 and Estado do São Paulo (São Paulo), 1875 - 1922.   This marks a big change in the availability of these two sources.  Previously, researchers in the U.S. could only get these sources at a few select research libraries.  In Brazil, they are available in the National Library and a few other places, such as the RJ and SP state archives. 

The site is fairly easy to use, offering browsing of each page and article directly through the website or through a .pdf.  I found the pdfs easier and faster to use, although the embedded window viewer highlights search words.

The above image shows the leading story from October 29, 1899, with the dreadful declaration that doctors had diagnosed bubonic plague in Santos.  The bubonic plague, fortunately, did not take on epidemic proportions, but it did spread up the coast, killing in Rio de Janeiro and other sea-board cities.   The plague also helped prompt the Republican, state, and municipal governments to create a series of overlapping urban disease eradication programs (including Rio de Janeiro's, famously directed by Oswaldo Cruz) that eventually contributed enormously to reducing the risk of several of the biggest risks of the day, including yellow fever and gastrointestinal diseases.

The company that offers this product to university libraries or departments gives a description of the collection here. 

One Day of Deaths in Rio de Janeiro

 "Nineteenth-Century Rio de Janeiro Address Locator," Stanford Spatial History Lab and Cecult (UNICAMP), 2009.

This map shows the location of 18 men, women and children who died on October 1, 1884 in Rio de Janeiro.  These obits were reported by the Jornal do Comercio, on October 3.  The newspaper regularly printed lists of deaths in the city, collected from reports made by the public and private cemeteries in Rio. 

This map serves to showcase a neat new tool available on the web for spatial representation of nineteenth century data for Rio de Janeiro.  The tool was developed by a team headed by Zephyr Frank, who are part of the Stanford University Spatial History Lab.  They also collaborated with Cecult (UNICAMP) in Brazil.  It is available here.

Below, I've included a table with details about the 29 people who died on October 1, 1884.  The first column (“KEY”) refers to the numbers on the map.  There are more people in the table than points on the map because some people either died on locations outside of the map area or could not be located.

A single day creates an insufficient sample to say much about disease in this city.  We do see that this was not a period in which there was a major epidemic, such as yellow fever or smallpox. During the worst scourges, epidemic diseases killed more people than regularly occurring afflictions.  The top killer this day, tuberculosis was probably the most lethal disease in the nineteenth century.  There are no clusters or patterns that are immediately obvious.  I am surprised to see no deaths in the densely populated downtown area.  This may indicate that the newspaper was not reporting all deaths. 

 

Brazil's Era of Epidemics

This is from my final report, submitted to the National Endowment for the Humanities.  To see the full report, click here.

During the first half of the nineteenth century, there is little evidence of major epidemic activity beyond smallpox, measles, and scarlet fever in Brazil. Indeed, much of South America appears to have been spared from the cholera and influenza pandemics that killed millions in Asia, Europe and North America. Brazilians and foreign visitors noticed the country’s apparent immunity to these diseases. In fact, Brazil’s reputation of salubrity was widespread and frequently repeated in government publications and travelers’ reports. In late 1849, however, a strange new disease appeared in Bahia before spreading to Rio de Janeiro and other large Brazilian seaboard cities. The malady was recognizable as yellow fever to foreign doctors who had seen similar symptoms elsewhere. But the Emperor hesitated for more than a year to officially declare yellow fever’s presence, probably because he and his ministers (correctly) feared the damage this would do to its international reputation.

Optimists predicted that Brazil would return to its previous good health after simple sanitary reforms, but they were soon proven terribly wrong. Once yellow fever gained a foothold on the shores of Brazil, it persisted and eventually worsened. In fact, epidemics of yellow fever struck during the wet seasons repeatedly in the 1850s. After a hiatus in the 1860s, it reappeared in the early 1870s and was a serious problem for residents of Brazilian cities and foreign sailors arriving in Brazilian harbors until the early 1900s. Not until Walter Reed confirmed Carlos Finley’s hypothesis that the aedis aegypti mosquito was the disease vector could notable Brazilians like Oswaldo Cruz, Adolpho Lutz, and Guilherme Alvaro initiate eradication campaigns. These campaigns successfully diminished the breeding populations of the mosquito, lessening the grip of this dangerous disease in urban areas.

Yellow fever was not the only destructive disease that made an appearance. Cholera and bubonic plague were also new and deadly arrivals during these six decades. Cholera struck first in 1855, creating one of Brazil’s most virulent epidemics in recorded history, matched only perhaps by the smallpox epidemics that desolated indigenous populations in the sixteenth century. It reappeared in a weaker form in the 1860s throughout Brazil and then in the Southeast in the 1890s. Added to this problem, the first officially diagnosed cases of bubonic plague were recorded in Santos, in 1899. During this year and the next, new cases of plague were diagnosed in Rio de Janeiro, Recife and other Brazilian cities creating a great tide of fear, spurring new energy and investment into sanitary reform programs. Bubonic plague killed many, but never became epidemic.

Read more...

Top Causes of Death in Porto Alegre, 1850s and 1870s

I am happy to see that the first results of my research on disease and health in nineteenth century Brazil has been published by The Americas here. In this article, I argue that enslaved and free people were largely killed by the same things. I make this claim using data from Santos, a coastal township in Southeastern Brazil. Slaves and free didn’t share every disease in the township. For example, yellow fever killed many more people of European descent, while I found smallpox to be proportionally worse among slaves.

In the Era of Epidemics project, I am attempting to look at disease and epidemics in Brazil. To do so, I have collected data and information from a number of locations, including the far southern state of Rio Grande do Sul. In its state capital, Porto Alegre, I was lucky to get my hands on an extraordinary run of cemetery data. The dataset, created by archivists in the Misericordia Hospital, includes more than 50 thousand names of slaves and free people who died between 1850 and 1896. Among many other bits of information, cause of death was usually reported

I still have a long way to go before I get this database in shape for analysis, but I was able to take a quick look at the top causes of death of enslaved and free people in the 1850s and 1870s. In the tables below, I list the afflictions that caused the most death and compare the two groups and decades. Compared to Santos, some of these diseases differed. Most notably, cholera took an enormous toll in the 1850s in Porto Alegre, especially among the slaves. This disease never became epidemic in Santos, but the 1855-56 epidemic in Porto Alegre was one of the worst urban epidemics in Brazilian history. Other diseases were shared between the two townships, including tuberculosis, smallpox, gastrointestinal diseases, and tetanus.

Top Causes of Death, Porto Alegre, 1850-1859

	disease	Slave %	Rank	Free %	Rank
1	Cholera	16.0	1	12.7	1
2	Tuberculosis	6.4	2	11.0	2
3	Diarrhea	2.9	6	6.1	3
4	Dysentery	5.4	3	4.7	4
5	Gastroenteritis	4.2	4	4.0	5
6	Tetanus	4.1	5	3.0	6
7	Smallpox	2.0	10	2.8	7
8	Heart disease	2.4	9	2.5	8
9	“Dentition”	2.5	8	2.4	9
10	Pneumonia	2.5	7	2.1	10
11	Unknown	1.3		1.6

Note: There were a total of 3181 deaths of slaves and 9298 deaths of free people.

Source: Cemetery records, Arquivo de Santa Casa de Misericórdia de Porto Alegre

Top Causes of Death, Porto Alegre, 1870-1879

	Disease	Slave %	Rank	Free %	Rank
1	Tuberculosis	11.7	1	11.1	1
2	Smallpox	7.1	2	5.6	3
3	Gastroenteritis	2.7	7	6.1	2
4	Heart disease	5.2	3	2.9	6
5	Bronchitis	1.0	10	3.3	5
6	Diarrhea	1.5	8	3.3	4
7	“Cerebral congestion”	3.2	6	2.7	7
8	Pneumonia	4.4	4	2.4	10
9	Tetanus	3.4	5	2.4	9
10	Birth problem	1.1	9	2.5	8
11	Unknown	3.3		9.8

Note: There were a total of 1236 deaths of slaves and 10,769 deaths of free people.

Source: Cemetery records, Arquivo de Santa Casa de Misericórdia de Porto Alegre

What I find interesting about these results is that while slaves and free people appear to have shared the top causes of death for the 1850s, there was greater divergence between the groups by the 1870s. I believe that this is due more to age differences than any differences in disease environments between the groups. The international slave trade ended for Brazil in 1850 and without new young slaves entering and without a capacity of this group to naturally reproduce at normal rates, slaves were part of an aging population. In contrast, the free population was expanding due to the arrival of thousands of European immigrants who were typcially single men of working age. Thus, we see that heart problems and pneumonia were proportionally worse for slaves by this decade.  

As more comes from this dataset, I will post...

The Archive of the Instituto Histórico e Geográfico Brasileiro in Rio

This week I am exploring the collection at the Instituto Historico e Geografico Brasileiro (IHGB) in Rio de Janeiro.  This past month I have been busy with class preparations and a paper on the internal slave market for LASA, but I am finally back to the Era of Epidemics project.  Anyway, the IHGB was founded in 1838 and is one of the oldest research and document preservation institutions in Brazil. They have a website, but because their catalog isn’t online, you can only find out what they have by going up to their 10^th floor reading room. As I had hoped, their collection of nineteenth century material is quite good. I came across a number of texts that I have not found elsewhere, including in Don Cooper’s enormous collection. I have compiled a list, available here, on documents and books relating to the history of medicine and health in the nineteenth century held by the IHGB.

The IHGB is in easy walking distance from the Biblioteca Nacional and I recommend that anyone doing serious research in the BN also stop by the IHGB to see what they might have that is not in the National Library. One drawback: they do not allow digitization. I asked Pedro Tórtima, one of their main librarians, if they have a reproduction service. He said that they will make a copy of a recent book but charge 25 reis ($13) per page! In other words, bring your notebook and leave your camera at home.

Para Português, clique aqui:

Update on Wednesday, June 24, 2009 at 6:23AM by Ian Read

I discovered that they might be persuaded to xerox at a price lower than what I quoted above, but this requires getting to know the archivists a little bit. They won't xerox old, fragile documents (which is good). There seems to be an "informal" way of getting the copying done.  Ah, Brazil, the land of the "jeitinho."

Yellow Fever's Evolution in the Western Hemisphere

Yellow Fever Outbreaks, 1800-1900 from Ian Read on Vimeo.

As far as I know, this is the first map to show regional yellow fever outbreaks during the nineteenth century, and certainly the first of its kind to be animated.  I recommend you enlarge the video to full screen for much better resolution.  Red dots indicate coastal infections, while the rarer inland infections are represented by yellow dots.  Infection location names are listed in the left column.

The area that yellow fever occupies shifts considerably, from most outbreaks before 1850 in the Caribbean, gulf region and American eastern seaboard.  After 1850, yellow fever remains active in the Caribbean, but there are many epidemics in South America, mainly Brazil while US outbreaks diminish noticeably.

The range of yellow fever changed when more and more ships brought African slaves, immigrants and California 49ers into Brazilian ports during the 1840s.  I believe these ships carried a dangerous stowaway that had disappeared from Brazilian shores for many decades:  the Aedis aegypti mosquito.  This mosquito is almost always the transmitter of the disease and it does best in urban areas where there are small collections of water and many non-immune human hosts.  Like the Asian Tiger Mosquito that is today partly blamed for the growing spread of West Nile virus in the US and Europe, the Aedis aegypti travel well in ship, trains and trucks, spreading the yellow fever virus when given the chance.

The History of Brazilian Health and Disease in Textbooks

Today I intend to look how the “era of epidemics” is represented by popular textbooks on Brazilian history that are available in the U.S. I find that what one might call the “popular authoritative history of Brazil” says far too little about health and commits factual errors. My purpose is not to criticize these books, but to show that there is still so much to be learned about a series of epidemics that killed hundreds of thousands and destabilized the country for decades and the efforts to fight them.

Just to be clear, what I am calling a "textbook" is a narrative that organizes a broad sweep of history into a thread devoted to the development of Brazil as a nation.  These books help guide classes from logical beginnings to the Brazilian nation as it "is" today.  There are a handful of textbooks in English available for a survey of modern Brazilian history, but only four are commonly used. Here is a list with today’s Amazon.com sales rank:

There are a series of related events that I think should be included in any textbook on Brazil because they exerted a lasting consequence on the development of Brazil as a nation and Brazilians within a defined sociocultural area.  Before 1849 Brazil was widely believed by foreigners and nationals to be healthy place, healthier in fact than North America or Europe.  This ended in 1849 when yellow fever took on a terrifying form as an urban epidemic. It reappeared many times after this, increasing in virulence and unexpectedly spreading into the interior by the 1870s. The cholera epidemic of 1855-56 was the most destructive epidemic Brazil had experienced up to that point (excluding, perhaps, the smallpox epidemics that decimated indigenous groups in the sixteenth and seventeenth centuries). Finally, smallpox caused more deaths during the second half of the nineteenth century because more people crowded together in urban areas. Despite the attention of these epidemics, tuberculosis and neonatal tetanus killed far more Brazilians.  All of these deadly diseases became far less of threats by the 20th century.  In the early 1900s, mosquito campaigns eradicated yellow fever from most urban areas, vaccination campaigns immunized Brazilians against smallpox, and chlorinization and other sanitary measures greatly reduced cholera and gastrointestinal diseases from water and foods.  As a result, mortality levels dropped and the overall public health improved in the early 1900s, thus ending this unusual six-decade epidemiological period.  Although most historians credit Brazil's exponential growth between 1890 and 1920 to European immigration, a far more important driver of this growth was natural increases caused by better public health.

This is my broad narrative, backed up by evidence that I have listed in this journal and in the source gallery. Do the textbooks on Brazilian history paint a similar picture?

One author attributes epidemics as one of the causes for “the shift of support away from the Monarchy” and lists “smallpox, cholera, yellow fever, plague” as the main infectious diseases. He does not give any more details about these scourges. While I believe that disease did weaken the monarchy (but this remains to be proven), plague occurred for the first time in Santos in 1899, a decade after the monarchy was toppled.

Later in this same textbook, the author spends a good deal of time on the urban revolts in Rio de Janeiro in 1904 that were prompted, but only in part, by a compulsory vaccination program. Several other authors also write much more about this fairly minor urban revolt than enormous amount of hardship and grief that these diseases caused or the remarkable successes that public health officials had in the early twentieth-century.

One textbook sets the stage for the anti-vaccine revolt with several mistakes that should have been caught by the author or the reviewers.  He writes the Republican government “decreed that all residents must be vaccinated against yellow fever, under a program administered by Oswaldo Cruz of the Pasteur Institute.” First, the vaccination campaign of 1904 in Rio de Janeiro was for smallpox, not yellow fever. This is not a minor detail, since it is widely documented that the Brazilian government had supported and promoted a nation-wide variola (smallpox) vaccination program for more than a 100 years, often against a great deal of popular resistance. Furthermore, popular mistrust was justified: officials reported in the provincial reports that the smallpox vaccine sometimes killed recently immunized, while others who had been supposedly “immunized” were later killed by disease. Smallpox vaccination still presents a small risk today, and people had good reasons to be afraid of it in 1904.  The second, more trivial error is that while Oswaldo Cruz studied briefly under Pasteur, he never officially represented the Pasteur Institute.  The Instituto Pasteur was founded in São Paulo in 1903 to research rabies, but was not involved with the Sanitary Campaign in Rio.

Another commonly assigned textbook runs into mistakes. This author claims that the “Brazilian authorities were alarmed by the outbreaks of yellow fever and cholera in the 1840s. Medical researchers traced the source of these epidemic diseases to recently arrived African slaves, providing another powerful piece of self-interest for ending the trade.” Unfortunately, this author seems to have gotten his dates wrong, with some consequences for his claim. Yellow fever struck in the final months of 1849 and cholera in mid-1855. Yellow fever may have been a “piece of self-interest” for some opposed to the slave trade, but it was commonly believed that Africans, and thus imported slaves, had innate resistance to the fever (epidemiologists today believe that African born people have greater innate resistance to yellow fever relative to other groups). Did this author confuse yellow fever and smallpox?   In one little known but important study, Dauril Alden and Joseph C. Miller demonstrated that smallpox epidemics in Africa and Brazil coincided.  Either way, cholera was certainly not yet on the minds of officials who passed the decree ending the international slave trade to Brazil in 1850.

Other textbooks are more accurate, although none spend sufficient time on the diseases and their impact. Only one textbook avoids the temptation to overemphasize the vaccine revolts, choosing instead to give some evidence for the benefits of the sanitation campaign. He writes: “Oswaldo Cruz’s energetic and effective campaign made the capital [Rio de Janeiro] as healthy as any contemporary European city.” He then backs up this statement with figures showing that yellow fever disappeared in Rio de Janeiro between 1903 and 1906. According to government reports, mortality levels in Rio de Janeiro were indeed similar to European cities by 1906, but this may have excluded large parts of city, unrecognized by the government, where mostly poor people lived miserably, many who were former slaves or children of slaves.

Perhaps the best textbook in terms of history of disease and public health in Brazil is James Hufferd’s little known and self-published Cruzeiro do Sul. He gets dates and disease propensity right when talking about Bahia: “the year 1860 itself was a year of seca [drought]—what turned out to be the first of three severe ones in succession—and yellow fever, almost endemic since 1849, continued devastating the white, or almost-white, part of the population” (Vol. II, pg. 163). And this is the best textbook in describing the sanitary campaign in Rio: “The already eminent Dr. Osvaldo Cruz was appointed to head up the effort against this recurrent [smallpox] plague, which killed 584 city residents in 1903, the year the campaign began, and some 4000 during the concurrent years-long epidemic. Cruz adopted techniques employed by North American health officials in eradicating yellow fever first in Cuba, then in the canal area of Panama” (pg. 263).